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‘The Citadel’; it may be fiction but the warnings it carries are real.

I had always intended to read The Citadel, the 1937 novel by doctor and writer A.J. Cronin. Now, having received a copy as a Christmas present I have finally got around to it. So why is it important?

One of Cronin’s first posts in the medical profession was in Tredegar in South Wales during the 1920s and a large portion of The Citadel novel is directly based on his experiences. Now an exile, I was born and raised in the town (though a little while later!), but quite apart from the personal connection, it is a vital read for anyone interested in protecting a freely available citizen-centred Health Service.

The novel tells the story of a young assistant doctor, Andrew Manson who cares for the miners and their families. Later in the story, Cronin candidly examines the ethical background to the dysfunctional system by having his protagonist move to London and falling to the temptation of money.

The Citadel pulled no punches in detailing the iniquities and incompetence of the medical profession as encountered by Cronin. Greed and quackery is rife. Predictably, the book was controversial and made enemies in the medical profession. The British Medical Association was driven to reply to Cronin’s accusations and there was a determined effort by one group of specialists to get The Citadel banned. One critic dismissed it as “dramatized pamphleteering.” But A.J. Cronin was insistent, telling the Daily Express in an interview:

I have written in The Citadel all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug … The horrors and iniquities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system

Today we take it for granted that there is a large cadre of dedicated doctors and consultants. Whilst private patients are still with us the clinicians have a good reputation and the men and women in the white coats generally are highly respected. But Cronin’s work reveals a dangerous aspect of a privatised health service; greedy and lazily incompetent doctors. In such an environment the rich may be able to take them to court for malpractice, but what of the rest of us?

Warnings of a fully privatised health service where the only protection was afforded by working men grouping together to collectively purchase medical services must not be dismissed lightly. They are stark. The Citadel may be fiction, but the evidence from the United States demonstrates that the warnings are real.